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PPI di Unit Gigi

Purnomo Hadi
Mikrobiologi FK UNDIP
CDC. MMWR 2003;52(No. RR-17)

http://www.cdc.gov/oralhealth/
infectioncontrol/guidelines/index.htm

Latar belakang:

Pasien maupun petugas perawatan gigi/dental


health care personnel (DHCP) dan
terpaparpathogens
Risiko kontak dengan:

darah,
sekresi mulut,
sekresi pernafasanoral
peralatan terkontaminasi

Prosedur yang tepat dapat mencegah


transmissi infeksi antara pasien dan DHCP

Cara Transmisi

Kontak langsung dengan darah atau cairan


tubuh lain
Kontak tidak langsung dengan alat atau
permukaan terkontaminasi
Kontak dengan selaput lendir pada mata,
hidung, atau mulut dengandroplets atau
percikan
Inhalasi mikroba airborne

Rantai Infeksi
Pathogen
Susceptible Host

Entry

Source

Mode

Standard Precautions

Diterapkan pada semua pasien


Kewaspadaan terhadap penularan
mikroba dari darah dan juga:
Cairan tubuh, sekresi, maupun ekskresi,
kecuali keringat
Kulit yang tidak utuh
Selaput mukosa

Element Kewaspadaan Standard

Cuci tangan
Penggunaan sarung tangan,
masker, pelindung mata, dan gaun
Peralatan perawatan pasien
Permukaan lingkungan
Pencegahan luka

Elemen PPI untuk Personnel Kesehatan

Pendidikan dan latihan


Imunisasi
Menejemen pencegahan paparan dan paskapaparan
Menejemen kondisi medis dan penyakit yang
berhubungan dengan pekerjaan
Pemeliharaan rekaman kesehatan

PPI Penyakit Menular lewat darah

Contoh Penyakit:

hepatitis B virus (HBV),


hepatitis C virus (HCV),
human immunodeficiency virus (HIV)

Karakteristik:

Dapat ditularkan di kegiatan pelayanan kesehatan


Dapat menyebabkan penyakit kronis
Sering dibawa oleh seseorang yang tidak
menyadari terinfeksi

Potensi rute penularan dari


Bloodborne Pathogens
Pasien

DHCP

DHCP

Pasien

Pasien

Pasien

Concentration of HBV in Body Fluids


High

Blood
Serum
Wound exudates

Moderate

Low/Not Detectable

Semen
Urine
Vaginal Fluid
Saliva
Tears
Breast Milk

Feces
Sweat

Konsentrasi HBV pada cairan tubuh


Tinggi

Moderat

Darah

Semen

Serum

Cairan vagina

Cairan luka

Saliva

Rendah/Tidak
terdeteksi

Urine
Faeces
Keringat
Air mata
ASI

Estimasi Insiden InfeksiHBV diantara HCP dan Populasi


Umum,
United States, 1985-1999

Health Care Personnel

General U.S. Population

Percent

Infeksi HBV pada U.S. Dentists

Yea
Source: Cleveland et al., JADA 1996;127:1385-90.
r
Personal communication ADA, Chakwan Siew, PhD, 2005.

Kepentingan Hand Hygiene:


Tangan

merupakan cara utama


penularan infeksi

Menurunkan
Mencegah

penyebaran MDRO

HAIs

Personal Protective Equipment(PPE)/


APD

Komponen major Kewaspadaan Standard

Melindungi kulit dan selaput mukosa


terhadap pemaparan materi infeksius yang
memercik atau menyemprot

Harus dibuka ketika meninggalkan area


perawtan

Sterilisasi dan disinfeksi Peralatan


Perawtan pasien

Peralatan Kritis
Peralatn semi kritis
Peralatan non-kritis

Instrument Processing Area

Dirancang agar terkendali kualitas dan


keamananannya
Dipisahkan dalam beberapa area kerja:

Receiving, cleaning, and


decontamination
Preparation and packaging
Sterilization
Storage

Kategori Lingkungan Permukaan

Permukaan kontak klinik


Sangat berpotensi terkontaminasi
langsung dari semprotan atau percikan
atau kontak dengan sarung
tanganDHCPs

Permukaan perabot rumah


Tidak kontak dengan pasien atau
peralatan

Kemungkinan kecil menularkan penyakit

Clinical Contact Surfaces

Housekeeping Surfaces

Sampah Medis
Tidak

infeksius: anggap sebagai


sampah domestik biasa

Regulated

Medical Waste: Jenis


sampah yang mempunyai risiko
infeksi selama penanganan
maupun pembuangan

Dental Unit Waterlines, Biofilm,


and Water Quality

Saluran air dan Biofilm di Unit Gigi:

Biofilm:

microbial biofilms
terbentuk pada lubang
kecil bore dari dental units
Merupakan sumber
mikroba

Pusat pasokan air


(PDAM) merupakan
sumber utama mikroba

Dental Unit Water Quality

Using water of uncertain quality is


inconsistent with infection control
principles
Colony counts in water from untreated
systems can exceed 1,000,000 CFU/mL
CFU=colony forming unit

Untreated dental units cannot reliably


produce water that meets drinking water
standards

Kualitas Air Unit Gigi


Untuk penangnan gigi
standar, sama dengan
persyaratan standar untuk
air minum.*
* <500 CFU/mL of heterotrophic
water bacteria

Cairan Irigasi Steril

Gunakan pada saat


melakukan coolant/irrigator
prosedur operasi

Gunakan alat yang dirancang


menjamin pemakaian cairan
steril

Special Considerations

Dental handpieces and


other devices attached
to air and waterlines
Dental radiology
Aseptic technique for
parenteral medications
Single-use (disposable)
Devices
Preprocedural mouth
rinses
Oral surgical procedures

Handling biopsy
specimens
Handling extracted
teeth
Laser/electrosurgery
plumes or surgical
smoke
Dental laboratory
Mycobacterium
tuberculosis
Creutzfeldt-Jacob
Disease (CJD) and
other prion-related
diseases

Dental Handpieces and Other Devices


Attached to Air and Waterlines
Clean

and heat sterilize intraoral


devices that can be removed from
air and waterlines
Follow manufacturers instructions
for cleaning, lubrication, and
sterilization
Do not use liquid germicides or
ethylene oxide

Components of Devices Permanently


Attached to Air and Waterlines
Do

not enter patients mouth but


may become contaminated
Use barriers and change between
uses
Clean and intermediate-level
disinfect the surface of devices if
visibly contaminated

Saliva Ejectors

Previously suctioned fluids


might be retracted into the
patients mouth when a
seal is created
Do not advise patients to
close their lips tightly
around the tip of the saliva
ejector

Dental Radiology

Wear gloves and other appropriate


personal protective equipment as
necessary
Heat sterilize heat-tolerant radiographic
accessories
Transport and handle exposed radiographs
so that they will not become contaminated
Avoid contamination of developing
equipment

Parenteral Medications

Definition: Medications that are injected


into the body
Cases of disease transmission have been
reported
Handle safely to prevent transmission of
infections

Precautions for Parenteral Medications

IV tubings, bags,
connections, needles, and
syringes are single-use,
disposable
Single dose vials

Do not administer to multiple

patients even if the needle on


the syringe is changed
Do not combine leftover
contents for later use

Single-Use (Disposable) Devices

Intended for use on one patient during a


single procedure
Usually not heat-tolerant
Cannot be reliably cleaned
Examples: Syringe needles, prophylaxis
cups, and plastic orthodontic brackets

Preprocedural Mouth Rinses


Antimicrobial

mouth rinses prior to a


dental procedure
Reduce number of microorganisms in
aerosols/spatter

Decrease the number of microorganisms introduced


into the bloodstream

Unresolved

issueno evidence that


infections are prevented

Oral Surgical Procedures

Present a risk for microorganisms to enter


the body

Involve the incision, excision, or reflection of


tissue that exposes normally sterile areas of
the oral cavity
Examples include biopsy, periodontal
surgery,
implant surgery, apical surgery, and
surgical
extractions of teeth

Precautions for Surgical Procedures


Surgical
Scrub

Sterile Irrigating
Solutions

Sterile Surgeons
Gloves

Handling Biopsy Specimens


Place

biopsy in sturdy,
leakproof container

Avoid

contaminating
the outside of the
container

Label

with a biohazard
symbol

Extracted Teeth
Considered

regulated
medical waste
Do not incinerate extracted teeth

containing amalgam
Clean and disinfect before sending to
lab for shade comparison

Can

be given back to patient

Handling Extracted Teeth


in Educational Settings
Remove

visible blood and debris


Maintain hydration
Autoclave (teeth with no
amalgam)
Use Standard Precautions

Laser/Electrosurgery Plumes and


Surgical Smoke

Destruction of tissue creates smoke that


may contain harmful by-products
Infectious materials (HSV, HPV) may contact
mucous membranes of nose
No evidence of HIV/HBV transmission
Need further studies

Dental Laboratory
Dental

prostheses, appliances,
and items used in their making
are potential sources of
contamination

Handle

in a manner that protects


patients and DHCP from exposure
to microorganisms

Dental Laboratory

Clean and disinfect prostheses and


impressions

Wear appropriate PPE until disinfection has


been completed

Clean and heat sterilize heat-tolerant items


used in the mouth

Communicate specific information about


disinfection procedures

Transmission of
Mycobacterium tuberculosis

Spread by droplet nuclei


Immune system usually prevents spread
Bacteria can remain alive in the lungs for
many years (latent TB infection)

Risk of TB Transmission in Dentistry


Risk

in dental settings is low

Only

one documented case of

transmission
Tuberculin

skin test conversions

among DHP are rare

Preventing Transmission of TB in
Dental Settings

Assess patients for history of TB


Defer elective dental treatment
If patient must be treated:

DHCP should wear face mask


Separate patient from

others/mask/tissue
Refer to facility with proper TB
infection control precautions

Creutzfeldt-Jakob Disease (CJD)


and other Prion Diseases

A type of a fatal degenerative disease of


central nervous system

Caused by abnormal prion protein

Human and animal forms

Long incubation period

One case per million population worldwide

Infection Control for Known CJD or


vCJD Dental Patients

Use single-use disposable items and


equipment
Consider items difficult to clean (e.g.,
endodontic files, broaches) as single-use
disposable
Keep instruments moist until cleaned
Clean and autoclave at 134C for 18
minutes
Do not use flash sterilization

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